| NPI | 1659778546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9860) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6153) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2020-07-17 |